No Kidding: Fit to be Tied? Talking with Dr. Rebecca Kluchin

Does the history of sterilization have links to modern consent forms? How has forced sterilization intersected, if at all, with the fight for women's right to be voluntarily sterilized? Since I have a lot of questions about these sorts of things, I figured I'd ask someone who knows.

Rebecca M. Kluchin, Ph.D., an assistant professor in the department of history at California State University, Sacramento, and author of the book Fit to be Tied: Sterilization and Reproductive Rights in America, 1950-1980, was kind enough to answer some questions via email about the history of forced sterilization, the stigma of voluntary sterilization for childfree people, and how the struggles for and against sterilization have differed.

How have twentieth century compulsory sterilization programs altered the dialogue around women's fertility options?

Forced sterilization in the 1960s and 1970s shaped family planning policies in that era, especially around issues of informed consent. This is probably the way in which it most shaped contemporary conversations about reproductive choices and reproductive practices. For example, federal sterilization guidelines established in 1978 spell out clear requirements for informed consent and cover things like how an interpreter must be present in instances in which English is not a woman's first language, and the consent form must appear in the language of origin and must clearly state that there are no consequences to not accepting the surgery. These are things that we take for granted now, but the experiences of victims of forced sterilization played a role in shaping these policies. Before they were established many women were forced to "consent" to surgery while in labor and under duress and/or the influence of pain medication. Some were not consulted about their sterilization; doctors sterilized them without their knowledge while they were undergoing abdominal surgery. Others were told to sign a form after they were sterilized and still others signed consent forms thinking that their tubes could be untied easily. In this way, forced sterilization has contributed to the development of contemporary informed consent policies, although follow-up studies of federally funded sterilizations that were undertaken in the 1908s reveal that some physicians continue to ignore federal standards for informed consent when sterilizing poor women, especially women of color.

How do you think the history of forced sterilization in the United States has affected the availability of permanent birth control?

In many ways, the history of voluntary and forced sterilization ran independent courses until the mid to late 1970s when they intersected during public debates about sterilization policy. Women seeking access to voluntary sterilization were predominately white but ranged from poor to middle class. When they were denied access to the surgery because of pronatalist hospital policies like the 120 rule, some filed suit and asked the courts to extend the recent right to abortion and birth control to sterilization. They were generally successful. Some victims of forced sterilization also filed suit, but with one exception, lost their claims.

In the 1970s, feminists advocating for sterilization on demand came into conflict with feminists and community activists seeking to protect poor women, especially women of color, from forced sterilization. The former wanted all barriers to surgery removed, in part because they feared that mandatory waiting periods and age minimums could be applied to abortion and used by anti-abortion policymakers to restrict women's access to the more controversial surgery. The latter feared that without such barriers, sterilization abuse would continue and advocated for federal and state regulation of voluntary sterilization as a means of protecting those vulnerable to abuse. Although both groups supported women's right to reproductive self-determination, they could not agree on how to achieve this in a way that protected the reproductive rights of all women. Protective mechanisms like age minimums and waiting periods inferred with women's right to sterilization on demand; their absence, however, allowed sterilization abuse to go unchecked as many women of color were being sterilized during childbirth, while under duress and often the influence of pain medication. Waiting periods prevented this common form of abuse from occurring. Federal guidelines were established in the 1978 and although they did not completely eradicate sterilization abuse, they did contribute to its decline. That said, concerns that protective mechanisms would restrict access to voluntary sterilization were not realized because the protections applied only to federally funded surgeries and were not extended to private pay patients.

Forced sterilization shaped the development of policies like the described above, but by and large, did not affect women's access to voluntary sterilization once the courts ruled that sterilization should be treated like birth control and policies like the 120 rule were rescinded. I think much of this is because the women seeking sterilization and women seeking to be protected from forced sterilization were of different races, classes, and ethnicities. In addition, while the history of forced sterilization is known in the academy and to some extent in the medical and family planning professions, it's not well known among the general public and thus doesn't really shape many contemporary women's views of sterilization.

What sort of stigma do you think voluntary sterilization carries, if any?

I don't believe there is much of a stigma for women and men who have had children, but I think one exists for those who choose to be childless and undergo sterilization to ensure they remain so. This is especially true for younger people, those under thirty, who have difficulty obtaining their desired surgery not because of policy barriers, but because of physicians' hesitation to sterilize them. Often physicians tell these patients to come back in a few years when they are "sure" about their decision. Federal guidelines established in 1978 require women and men sterilized with federal funds to be over twenty-one, but these rules don't apply to private patients and in my opinion, don't have any influence over the conversations between the childless in their twenties and physicians who refuse to sterilize them. I think physicians' hesitation reflects their concern about malpractice suits, but perhaps more importantly, reflects our society's continuing discomfort with decisions to remain childless as well as medical paternalism, which undermines women's reproductive decision-making.

Comments

I have a niece. She has Williams Syndrome. Among many characteristics of this syndrome the two that are pertinent here are "delayed development" and "heart anomalies". In lay terms, she is mentally handicapped and has a hole in her heart. A sad situation certainly for her parents. As she grew into puberty her parents realized that she indeed had a sex drive. Out of fear on many levels they chose to have her sterilized. The fears for their daughter were that she would get pregnant and as a result, perhaps die of a heart attack. They would loose their child and/or suffer unknown embarrassments. Do I agree with their choice? No. But the medical system did. Just puttin' it out there for the readers to ponder.

"Medical Apartheid; The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present" gives a good overview of why blacks don't trust the medical system. The author, H.A. Washington, does start to confuse race and class as it gets closer to present, but it's pretty good.